GW1--03558_Well Construction - GW1_20230519

•01,•;....fv.A-74,-,-;,,,i-,-,-,.-•....,7,:--.----,...-.-7,,,,. •_.- -,-..,,,,,;',.. ---..777:7,....77,.-7';';',..'--,7:1', '''4-7-.J-17.:-.-- ,.1.-Eir-,..-..-`..!..=.-...g------.--,,,;,.:?.::::f-!,;,;,,,, '",?.-':,-f_.s_,_ .0.,,, • ,,• - ',..1 --,
,0=' :'' ''''.. ''' 1',..'''',-% **=: .',. 7"',,,,:.,-,---,;.'",' ,';•, •''', ' ',• `•. . '. 'r ' ' ''' •, '-, : ..'''-.:44''' ,!,,': „ ..`'...'- 44,-,t 4.i4---'--,t.- :,--.7.1.'ic`'.-Te'lq.,,ar,-;'7ir., :..- 0-' i•
I -. , i , ..i•: ,„ 7,1,--„-..,, .:- -I, .- , ,,,, --, „ III 2; %,..,,-,,-• .41.,,$, .: ,f:' .rf...•:,,iv::,'„;., ‘;.,.-:,.41.9,,e.;:44-4.tkv,14-,N't„,,'!.*,Ayl„ifr,. -1.-/:.- .'• •-• ,
' ,,,,.. !1,1,,,....ztl.,:,v,, 4?:„.4-,',. :,..,,., ' ;,.„ii....-i-,.- '. ,..,,?°,e..',.),,-':-,,`,...7:, ..,,.'''.'",,'.-1,,,';',;,`P,,,"'„...t,,„.;-,,,,,,.,d.,'•, ...,,:t..4''''.... 4.21,,,,,,i P4,,,,..!'11').'4.,*.::".' ;-,),Itrt-4,4,:',"-Lf • • . ',
,; „,,, ...,.•,,,,i.....,...,;,;.,-,...„;,:., ...,,,..,;,t,;,,,,,,‘, „),...; •::-.-.„......„.„ ,.....,s,:i...,1,,,,,,t;:i..!...I.::,5,,,,;;.....f,.,..;.,-,,",c,„•T'..4,11Aii3x4i,it.,-..,".i.,,,, ...4.4.,itslroi,.-.44ii:::. ,•.-1,,,,.4 •,.;;,f1.:.:„,R.I•i'.-
' •1.,,,,.:4,:Arj'1,.,:::,,344%',,:;:,4111-:'1:_.4! 4.k:,,,V.:ilyt,^ .i'',':.;',',-F,ii P:iitte::1°,>`-`'t:.,u,,;'."',1 , -,,,‘-',-,.!.,!,:.,4'. --6.,,..'","17.-.-:;14:1;'--T.,;:;--i...; 1.1,:w.:‘ ikik.4.,:fli?..,,;;;'1F',11..".;;. - .
41.1 i
---..-t---4,- -%t4.,,-,-Jris, ,;1:-:',.4;.,;,:.,:-•;;,y,f',:':!,'-i.t-,::,. .‘;',-,;S"... ..'.--„,Z,Z-t,*'.,-..ti;...-;,.!:41v. ;':','`,.r.'"4".."4:41-1;0..e.Y.'i'F4jrtf'=...'-teS.*.f:" ":;.;;".•.";,,,,::,tli",%'f',.',Pri3,--'4: - ': - •
••vo-o-11,-V% :- -t..'-z-4,4,:-.03it-4-4;.-::„..-:•.-f?;,,,,...-40t.ipfk--,-.•.-4:414!„.4:-.0tia,."..-.1- ..7-,,•,4k.•-4.14.-411;,:4 V.41-,. ' .4..,,,,r,h-A,...-..,-z-.4,,,,,-,.',,,,,:-..`,..'•.7, ---"-• -. •
• :,......4 ,..,.,...„ ....,tevy,.,...:,,.. ,....,14,,,,,,,,,.„-,.•,,2.,•, ..1 ;=4„,..,„,,.,..,ov„_:,-1q11.•,4:7,1..,...r...-.....,A.,,,,p-s.,. 111,, 04--..t.t.1,-, ri ,.!-- ,,,,,.'il;-'kt....1„'t',',-; '.• '-- .',,, .
.,-,:,A. 4...,,034-:7,,.4.,,y ,„1*,...-.,!:',:lAjiltf:1-,4. ' lu,411,ie,.,-.,;3.. ,j,:t..;.,',i:j.,,o...41#:1145.!•p.1,44,Ytir"."..:rif?: P•-:.4.4. foqZ,;--',i'f.,,t--;":::";,':'.:••'1.- Form .
-.4.,..N,,,,t,..r..-: .10,.i';,.f,.T.,, -,4•„1.,,,4,1,.i.:.-,...,,•,to.,,,t..,,,,re,,,,,,.L.k.p,,,..,,..4.,..,:, •.,ta.r... r.',:".,-;.•-'; ;,"...-'!,'Y.•,,',".--:-.t;;,,,-':-'..,-- .,,- •-!...•:"-:•'."--,-'_:-."--`-; ,":,,- :,.::,--. ------,..,--- i.WELL 166 -' 4i.t.=
' 'se °'Y: .• '- '. ' - 1--J-.2
. - .
. . ...
. . ....,
L Well Contractor Information: \ . ..
. .
.:•.,r,1
. . ..•i
...Cameron Bazin
' 14.WATER TAWS
, .
. ,
INcil CoiutactErNtoasi . FROM TO _ DESCREVITON . . ,
•• 4518-A - • .IgS EL- . ft" //
. . .:
• R. ft. '
. ' . .
NC Well ContradarCertificatirsaliumber
15.01171CaleSSING Obi rmilti-coased wells)ORLD32atilf aPSlicabl6 '' -
•
• Aqua Prill,Inc. FROM TO DIAMETER . THICKNESS
. -MATERIAL
2(:), ft.. ci2_ ft 6_ fn., •':-
Cowpony-Name
_ .--
. ..
.16.INNER CASING OR TI3BING keethrami chaed.loop) - •• - ..
ri --.) in
:.
1Well Construction Permit& r) 1 /(0 to(ri . . FROM- TO - DIAMETER. THICKNESS MATERIAL
•
• ft' • ft. In.
List all appticabre well canstructkuipentrits(Le.LIIC.Cola*:State.Vattaltee.cia.)•
3.WellUse(cheolcwell use): . f4 ft." in. .
'
Watr.r Supply Well: 17.SCREEN
DIAMETER SLUTSIZE TRIC(CNESS MATERIAL _ ,..• '.,
....cultural • fjhriunici FROM TO palfPublic " ft•
' •
•
I(Geothermal(Rearing/Cooling Sopply)/gResiderdial Water Supply(single) ft.. fr. •in. .
'. iit ,.ustriallcormnertial . •°Residential IltfaterSupply(shared). 18.GRour .
FROM .•TO -- ' MATERIAL EMPLACEMENT METHOD&AMOUNT •
-I-%IiTiltatiell. - • .
_ FR
Nosi-WarSuinply Well:. 0 ft. 2,(1 ft. (....141.10
i 5 - .
- -
l Kt Monitoring • DRecovery ft. ft . •
1,.
..-
-njection Well:
7• ft. : • ft. . . .',.'....... • NI,. Ter Recharge E3GrotmdwaterRemerflaion
•-19.SANDTdRAVEL PACT((If applicable) -
• EMELACEMENT METROD ---.
i! 1{ -golfer Storage andRecovery E3SalinityDarrier FROM • TO .MATERIAL
.4'
' •
..- . ' d•quifer Test E3Strainwater Drainage ft. It.
: ,tiliExpraimentalTeebnology EtSulasida ace Control ft. it. . -/\.
i„
,17 Geothermal(Closed Loop) Drawer ,
21L%Wal.M. ',7r,143G 12;1661ml 6ttis2urcticfr.°22c5523)corroescpc.cichc.cte.)
i.i.:
; .••
riGashattosa(ieatiogiCooling lIctom) °Other(exploirtutider421•Remarks) FROc..) fr.. .3 it. li.
4.DateNVell(s)Completed: 571 7/-23 WellIftit 4 It! 2v5 ft• A OCAt, • -0.: . 5a.Well•Luea ft. ft.lion: - ..„,..._ r...-,,,, •......... ••-e••, a..km-...a.•
ft. • it• • (?''•:•1 r22fc:7.:
_Jyam Fipm • ft.• • ti.
•
ii- looffieitiounserNac= • Facility Ins ofepoiltableY . ,
' •
ec• . -
..: n., ft. 'iViikY 1 180 ZOCJ
il zr,-E4 Alusik era. k (.1_ 'E,•,067-&61.v..o co• • -, -- - •• -- -• - - ft. &FilysimiAddrc:s,coy,mdrip
t' E
, . it.RE:mat:As .
Yal talln. . ' "- -• 43W-0.1 60(..4.
. .
Cramty OcreetIdethirreatiiatio.(1.11\1) '
,
c • .
Latitude and longitude in degreedminutedseconds or declaim!&grecs: c c.a.. •
1r . tit-wail..01,1.,oe.ka.long 4 T.gr....cical.)
. , ...`
Li, :36 L I 77c> gp,YCo 5 2 .
6.is(are)jdie well(spPerinaneot or•DTemporary . .
st of Ceilified Well Ccmlnefor
. 3J'signing ihisAmla henbli azWiffi that the well(s Inas(ewe)constructed in.accordance
with ISA NCACOZC.0I00 or ISA NCAC MC.0200 Weil Con.ttnection Mandan&and that a if
., ......•.repair t..,,,,,,6..diting wen: Inves or No . ,
crarg
.c con trf this recordlas Occult:added ta thewelt omen.
,
1: 7-.S.----' ,--- jejyrazati - plate tile nature of:nu
thts is a pabl fitt out kna!vnivellcaustractton j . ,
1 Wider.#2I=odes sattiazi area Ole bucket/4f 7,3.Site diagram or sidditionalwellditalita
- You may.ase the back of this psge.oprovide additional well site details or.well
Gelpro• hafDPT or Cittscd-14)01315 was having the same construction detaks.You may also attach.additional pages ifneceisray, - '
cotEtrog'Par oo.on;only lemv_.....i.is- needed_.'hidi, cum, TOTALNUMBEKof Wells ,
t•
SIIDIKRITAL ERSTRUCTIONS
-..A.'.-
,• ,
. 24a
.;Far All Wells: Submit this form,'within 30 days of completion of well .. -•
IteloWLsod surface: •
.Tofallv411,136-10 .-' 1290'itn4 201014. condi-a:tient:the•followinF .,..-....'''': • •For'situldple ire&fist:al I deptIs vejr.gtzarnp
l ttentleyel below top . • .• (ft.) Dilation orWater Resources,Information Processing Unit, • '. •,.
-.
. . - .
ikSInic wa ,ofcantliN " • 1617111Q Service Centeri:lialeigb,NC 27699-1611 1.)
:. • 1'u:titer Idea fa aborqs=in&ia""f A! - . .
•
!-• ei . • . ' 24t.PDX'Inlection Wells: In addition to sending the form to the address in 24a
IL 3Borellude.diameter
above,,also Oubinit•cma cOpy of this.form within 31)days of completion of well • '.--
I.‘„
' Co-k-..,(- - - - --- ---- ----- --- construction loth°foliov.inF - " -_ _ - ::1'it
.i
,'. A.2.1ilkill'exagtruction meitiod: .
-,-
, (-Le.,mem loiciy,cable,cliatetfusb,'Ar..), Division of Ntirriter Ilbr.,ources,Undergrotmd Infection C.ontrol Program, .
163614ell Servics CenteriRaleigh;NC 276994636
. FOR WATE.R.SUPPLY WELLS ONLy: . •
..
. Rattled of fr,it... . 24c.Yor Water Snob'az Voterlion Wells: In addition-to sending the foma to
'‘ il
. .
l''''' 13n.Itield(gpro) I 2--- ' . the address(es)'alitrite,'.also submit Cad etipy of this form withia 30 days of
.
1-304e1/61°P WPg .01_14_ . jpanotin tl ____2 1 . • -Lout_ertiaticoonitrun ofelsalld construction to the conatihealth department of the county .
,001z• -----.7-- , h
- . -- - • . . .
..,:.
t:tell'-tY"Dkl.s#n of Water Rslowces -
i
Revised 2-Z7,.-2016
- Nardi Capita:u.•_.w.:,,.....-....,,,- FounGW4.• . . . . , . . •
, . . . •
. . . , .